Lifesaving Heart Care on the Coast

Adventist HealthOct 13, 2014 NW Regional Heart

Sam Mason didn’t think he was having a heart attack. The 64 year-old Manzanita resident thought that he was experiencing arrhythmia. “My heart was beating erratically,” he said: “pump, pump, pump, Ka-Chung. I could literally feel my rib cage move from left to right. I thought, this isn’t right.”

Sam was home alone at the time, and it didn’t occur to him to call 911. “There was a heaviness in my chest,” he said, “but it didn’t hurt much.” So Sam, a life-long athlete, decided to exercise. “I did some gentle rowing on my rowing machine,” he said. “After that my heart kind of settled down.”

The next morning, March 26, 2014 Sam went to the Manzanita Primary and Specialty Care Clinic at the urging of his boss. Sam is the corporate environmental manager at Tillamook County Creamery Association. “I called my boss and told him I was going to stop at the doctor’s office on my way to work. When I described my symptoms, he told me to go to the urgent care clinic in Manzanita; he figured that closer to home was better. He didn’t want me to drive to Tillamook until someone checked me out.”

That was excellent advice. Sam saw Rob Soans, Physician Assistant (PA) at the clinic in Manzanita. “Rob listened to me, and he said, ‘it sounds like there might be something going on with your heart.’ He gave me an EKG and a blood test.”

The blood test was to measure Sam’s troponin levels. Troponins are proteins which are released into the blood when the heart muscle has been damaged, such as in a heart attack. The more damage there is to the heart, the greater the amount of troponin there will be in the blood. Normal troponin levels are so low as to be undetectable. Sam’s troponin levels were high, indicating that he had experienced a heart attack the day before.

Team approach provides seamless care

While Sam Mason awaited his EKG and troponin blood test results at the clinic in Manzanita, Rob Soans called NW Regional Heart and Vascular cardiologist, Mark Hart, MD. Tillamook Regional Medical Center and its clinics on the coast operate in partnership with NW Regional Heart and Vascular to provide world class cardiac services to our patients in Tillamook and Lincoln Counties. Dr. Hart assessed the results of Sam’s EKG and his troponin levels by phone and told Rob to transport Sam by ambulance to Adventist Medical Center (AMC) in Portland.

“I thought they were going to take me to the hospital in Tillamook,” said Sam. “But Rob got Dr. Hart on the phone and he took a look at my results and decided to send me straight to Portland.”

Sam was transported by Tillamook Regional Medical Center Ambulance Service, which operates a station in Manzanita. Ninety-five minutes later Sam was being checked in to the cardiac catheterization laboratory (cath lab) at AMC-Portland where he had a coronary angioplasty; that’s where a catheter is threaded through the femoral artery and guided into the heart. A special dye is injected via the catheter which enables cardiologists to observe the heart and any blockages through x-ray imaging. The cardiology team discovered that Sam’s left anterior descending (LAD) artery in his heart was 99 percent occluded. This condition is known as a “widow maker.”

What is a Widow Maker?

“The good news is that I didn’t wake up dead.”

The LAD supplies blood to the entire front wall of the heart and much of the side wall. It is the main artery down the front of the heart. When it is totally blocked or has a critical blockage at the beginning of the vessel, it is known as the widow maker, (the medical term is proximal LAD lesion) because of the often fatal consequences if the whole front wall of the heart is denied blood and oxygen.

A coronary stent implant was placed in Sam’s occluded LAD artery following his angioplasty. A stent is a small, wire mesh tube about the size of a ballpoint pen spring. The stent is inserted to help keep the artery open to ensure blood flow in the heart.

Sam said, “I almost didn’t go to the doctor that morning because I felt better. I knew that something unusual had happened with my heart, but it didn’t really hurt.” Sam never dreamed that he’d experienced a widow maker heart attack or that he had a 99 percent blockage in his heart. Had he not gone to the clinic that morning and received expert care he very likely would have experienced a second major heart attack that could have lived up to its name: widow maker.

Sam’s cardiologist, Mark Hart, MD said “This is a great example of the team concept at work.” Dr. Hart is referring to the partnership between Tillamook Regional Medical Center and NW Regional Heart and Vascular and Adventist Medical Center-Portland. “I see patients in Manzanita,” said Dr. Hart, “and Rob Soans and I have prepared for this scenario: a patient comes in to the Manzanita clinic with heart symptoms. Rob gives them and EKG and tests their troponin levels. He calls me with the results and if necessary we transport the patient to AMC-Portland for treatment. We are working together to create an environment where patients get the same treatment wherever they are. Everything worked exactly the way that it should have here. It was seamless coordination.”

The Road to Recovery

Sam has committed himself to following instructions. He is taking his medications, keeping his appointments, going to cardiac education classes and he has changed the way he eats. He’s trying to eat five servings of fruits and vegetables per day and he’s given up coffee and sugary drinks. He’s lost 10 pounds and he is participating in the cardiac rehabilitation program at AMC-Portland.

Sam drives from Tillamook to Portland weekly to work out under the watchful care of exercise physiologists. Sam and his fellow cardiac patients wear cardiac monitors as they exercise and the rehab staff guide them to exert themselves within safe bounds while monitoring the stress on their hearts. For Sam, a lifelong athlete who has always enjoyed a strenuous workout, the challenge is to slow down. He’s supposed to keep his heart rate under 115, and just work to the point of mild exertion. He feels like he’s barely moving. The staff call to him, “Dial it back, Sam.” He smiles and tries to negotiate an intermediate speed. They laugh.

For Sherrie Evenson, exercise physiologist, Sam is a model patient. “I’ve been so impressed with him,” she said. “I’m impressed that he comes all this way. It says a lot about his dedication to his health that he drives here from Tillamook. And it makes a huge difference that he is a lifetime exerciser. He has a good foundation for health. And he’s just so nice. He’s a pleasure to work with.”

“This has been good for me,” said Sam of cardiac rehab. “Based on my experience here I know how far I can push myself.” Sam recently had the opportunity to push himself when he went to Italy with his wife, Cindy, to celebrate their 40th wedding anniversary. “We went on some hike and uphill climbs in Italy. I was able to pace myself based upon the knowledge that I’ve gained here in rehab.”

It was never far from Sam’s mind how close he came to not surviving to celebrate 40 years of marriage. The phrase “widow maker” is haunting. “It would have been so hard for my wife,” Sam said about the possibility that he might have died of a heart attack. “That’s why it’s so important to me that I received excellent, quality care.”